Abstract: Metabolic reprogramming is considered to be a hallmark of cancer and a potential source of novel targets for
diagnostic imaging and therapy in cancer. Imaging informative aspects of metabolism report on biologically and clinically
important features of tumor biology, enabling both prognostic counseling and tailoring of therapeutic regimens. Metabolic
imaging therefore has the potential to provide a new dimension of precision medicine. For brain tumor patient management, we
have serious issues of using conventional diagnostic images (contrast-enhanced T1w-MRI and T2/FLAIR) for surgery and
radiation therapy (RT) guidance. Especially, radiation therapy (RT) is as good as the images that guide RT planning. RT based on
conventional MRIs may not fully target tumor extent in glioblastomas (GBM), which may, in part, account for high recurrence
rates (60-70 percent at 6 months). Magnetic resonance spectroscopy, a molecular imaging modality that quantifies endogenous
metabolite levels without relying on perfusion, leakage and diffusion of injected material, may better define extent of
metabolically active tumor. In addition, advances in this technology now permit acquisition of whole-brain high-resolution 3D
spectroscopic MRI (sMRI) in 12-14 minutes. We correlated state-of-the-art sMRI metabolite maps and their ratio maps with
tissue histopathology to validate further its use for identifying non-enhancing and infiltrating tumors that may not be fully
imaged by conventional MRI sequences and provide support for its adjunctive use in tumor contouring for RT planning.
Integration of histologically-verified, whole brain 3D sMRI into RT planning is feasible and may considerably modify target
volumes. Thus, RT planning for GBMs may be augmented by sMRI potentially leading to reduced or delayed recurrence rates.
Hosted By: Zahi Fayad, PhD
Contact: Sybil Price (212) 824-8471 sybil.price@mssm.edu